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| 1 | AN ACT concerning insurance.
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| 2 | Be it enacted by the People of the State of Illinois,
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| 3 | represented in the General Assembly:
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| 4 | Section 5. The Illinois Insurance Code is amended by | ||||||
| 5 | changing Section 356z.2 as follows:
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| 6 | (215 ILCS 5/356z.2)
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| 7 | Sec. 356z.2. Coverage for adjunctive services in dental | ||||||
| 8 | care.
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| 9 | (a) An individual or group policy of accident and health | ||||||
| 10 | insurance
amended, delivered, issued, or renewed after the | ||||||
| 11 | effective date of this
amendatory Act of the 92nd General | ||||||
| 12 | Assembly shall cover
charges incurred, and anesthetics | ||||||
| 13 | provided, in
conjunction with dental care that is provided to a | ||||||
| 14 | covered individual in a
hospital or
an ambulatory surgical | ||||||
| 15 | treatment center
if any of the
following
applies:
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| 16 | (1) the individual is a child age 6 or under;
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| 17 | (2) the individual has a medical condition that | ||||||
| 18 | requires
hospitalization or general anesthesia for dental | ||||||
| 19 | care; or
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| 20 | (3) the individual is disabled.
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| 21 | (a-5) An individual or group policy of accident and health | ||||||
| 22 | insurance amended, delivered, issued, or renewed after the | ||||||
| 23 | effective date of this amendatory Act of the 99th General | ||||||
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| 1 | Assembly shall cover charges incurred, and anesthetics | ||||||
| 2 | provided by a dentist with a permit provided under Section 8.1 | ||||||
| 3 | of the Illinois Dental Practice Act, in conjunction with dental | ||||||
| 4 | care that is provided to a covered individual in a dental | ||||||
| 5 | office, oral surgeon's office, hospital, or ambulatory | ||||||
| 6 | surgical treatment center if the individual is under age 19 and | ||||||
| 7 | has been diagnosed with an autism spectrum disorder as defined | ||||||
| 8 | in Section 10 of the Autism Spectrum Disorders Reporting Act or | ||||||
| 9 | a developmental disability. A covered individual shall be | ||||||
| 10 | required to make 2 visits to the dental care provider prior to | ||||||
| 11 | accessing other coverage under this subsection. | ||||||
| 12 | For purposes of this subsection, "developmental | ||||||
| 13 | disability" means a disability that is attributable to an | ||||||
| 14 | intellectual disability or a related condition, if the related | ||||||
| 15 | condition meets all of the following conditions: | ||||||
| 16 | (1) it is attributable to cerebral palsy, epilepsy, or | ||||||
| 17 | any other condition, other than mental illness, found to be | ||||||
| 18 | closely related to an intellectual disability because that | ||||||
| 19 | condition results in impairment of general intellectual | ||||||
| 20 | functioning or adaptive behavior similar to that of | ||||||
| 21 | individuals with an intellectual disability and requires | ||||||
| 22 | treatment or services similar to those required for those | ||||||
| 23 | individuals; for purposes of this definition, autism is | ||||||
| 24 | considered a related condition; | ||||||
| 25 | (2) it is manifested before the individual reaches age | ||||||
| 26 | 22; | ||||||
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| 1 | (3) it is likely to continue indefinitely; and | ||||||
| 2 | (4) it results in substantial functional limitations | ||||||
| 3 | in 3 or more of the following areas of major life activity: | ||||||
| 4 | self-care, language, learning, mobility, self-direction, | ||||||
| 5 | and capacity for independent living. | ||||||
| 6 | (b) For purposes of this Section, "ambulatory surgical | ||||||
| 7 | treatment center"
has the meaning given to that term in Section | ||||||
| 8 | 3 of the Ambulatory
Surgical Treatment Center Act.
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| 9 | For purposes of this Section, "disabled" means a person, | ||||||
| 10 | regardless of age,
with a chronic
disability if the chronic | ||||||
| 11 | disability meets all of the following conditions:
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| 12 | (1) It is attributable to a mental or physical | ||||||
| 13 | impairment or
combination of mental and physical | ||||||
| 14 | impairments.
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| 15 | (2) It is likely to continue.
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| 16 | (3) It results in substantial functional limitations | ||||||
| 17 | in one or more of
the following areas of major life | ||||||
| 18 | activity:
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| 19 | (A) self-care;
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| 20 | (B) receptive and expressive language;
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| 21 | (C) learning;
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| 22 | (D) mobility;
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| 23 | (E) capacity for independent living; or
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| 24 | (F) economic self-sufficiency.
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| 25 | (c) The coverage required under this Section may be subject | ||||||
| 26 | to any
limitations, exclusions, or cost-sharing provisions | ||||||
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| 1 | that apply generally under
the insurance policy.
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| 2 | (d) This Section does not apply to a policy that covers | ||||||
| 3 | only dental care.
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| 4 | (e) Nothing in this Section requires that the dental | ||||||
| 5 | services be
covered.
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| 6 | (f) The provisions of this Section do not apply to | ||||||
| 7 | short-term travel,
accident-only, limited, or specified | ||||||
| 8 | disease policies, nor to policies or
contracts designed for | ||||||
| 9 | issuance to persons eligible for coverage under Title
XVIII of | ||||||
| 10 | the Social Security Act, known as Medicare, or any other | ||||||
| 11 | similar
coverage under State or federal governmental plans.
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| 12 | (Source: P.A. 95-331, eff. 8-21-07.)
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